MEDICARE: MICHAEL MATHESON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11460218-1202	UT

General Provider Information

NPI Number	:	1740822196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MATHESON DC

Provider Business Mailing Address
First Line	:	6216 S REDWOOD RD
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-6630
Country	:	US
Telephone Number	:	801-974-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	6216 S REDWOOD RD
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-6630
Country	:	US
Telephone Number	:	801-974-5555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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Directions to “ MICHAEL MATHESON DC” Practice Location

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